Mary Stephenson, a fifty-nine-year-old grandmother, visited dozens
of counselors and experimented with an array of antidepressants but
nothing worked to curb her suicidal feelings. (2) Janie McDowell, a
fifty-six-year-old housewife, suffered from hand tremors, leg-muscle
spasms, recurring nausea, chronic bladder and kidney infections, severe
depression, short-term memory loss, and slurred speech. (3) Freya Koss,
a former event planner, experienced dizziness and double vision.
Physicians misdiagnosed Koss with lupus, multiple sclerosis, and,
finally, myasthenia gravis. (4) The common theme among these medical
tragedies is that the above victims all returned to being healthy,
active adults after the removal of their mercury amalgam dental
fillings. (5)

Amalgam is the name dentists give the silver filling material used
to reconstruct damaged teeth. (6) Approximately nineteen out of every
twenty Americans suffer from dental cavities, and more than 200 million
people have at least one cavity in their mouth filled with dental
amalgam. (7) The amalgam composite contains a mixture of mercury,
powdered silver, tin, and copper. (8) Mercury, a highly toxic substance,
has been linked to neurological problems, gastrointestinal problems,
Alzheimer's disease, brain damage in children, cardiac dysfunction,
impaired kidney functioning, and a host of other ailments. (9) Experts
vehemently disagree on whether the mercury found in dental amalgam is in
a large enough quantity to be harmful to humans; however, the evidence
against using mercury in dental fillings continues to grow. (10) The use
of mercury amalgam dental fillings is dangerous, and there needs to be
national legislation to prohibit its use.

This paper begins with a historical look at the use of mercury in
dental fillings. Part III discusses the forms of mercury, while Part IV
discusses the composition of mercury amalgams. Part V focuses on the
mercury amalgam controversy and highlights the major arguments made by
pro-amalgam and anti-amalgam activists. Parts VI and VII, respectively,
explain why litigation and removal of fillings are insufficient remedies
for the mercury amalgam problem. Part VIII addresses the environmental
impact of mercury amalgams. Part IX examines legislation enacted in
other countries that prohibit, limit, or discourage the use of mercury
amalgams. Part X addresses the inadequacies of state-level legislation
as a solution. Part XI proposes national legislation as the best
solution to the mercury amalgam problem. Additionally, the final part
recommends changes to the currently proposed national legislation.

II. HISTORICAL OVERVIEW

The use of mercury as dental filling material is a practice with a
long history throughout the world. (11) The Chinese used a
mercury-containing "silver paste" as early as the seventh
century to repair decaying teeth. (12) Mercury intrigued the alchemists
of China because it is the only metal that is a liquid at room
temperature. (13) Furthermore, the ancient Chinese also knew that
shavings of other metals such as copper, tin, and silver dissolved in
liquid mercury. (14) By the early 1800s, the popularity of "silver
paste" for dental fillings had spread to England and France, (15)
eventually arriving in North America in the 1830s. (16)

Joseph Bell, a British chemist, created the modern amalgam filling
by combining melted coins and mercury. (17) The problem with this
compound was that the impurities in the metal used for coins caused the
amalgams to expand, which often caused the teeth to fracture. (18) Over
time, improvements were made in the mercury amalgam compound, which led
to a durable dental filling material. (19) Although the expansion
problem was solved, many dentists continued to express concerns about
the use of mercury in amalgams. (20) As early as the 1930s, it was
already a well-known and accepted fact that mercury exposure, even in
small amounts, could result in mercurial poisoning. (21)

In 1845, the American Society of Dental Surgeons (ASDS) advocated
strongly against the use of mercury amalgams and required its members to
sign a pledge to stop using mercury amalgams in their practices. (22)
Over the next decade, several members of the ASDS were suspended for
malpractice when they placed amalgam fillings in patients in violation
of their ASDS pledge. (23) Eventually, membership in the ASDS declined,
and it dissolved in 1856. (24) The American Dental Association (ADA),
founded in 1859, arose to take the place of the ASDS. (25) However, the
ADA's position on mercury amalgams was in direct opposition to that
of the former ASDS. The ADA strongly advocated for the use of amalgam as
a safe tooth-filling material. (26) The public was receptive to the use
of amalgam fillings because their only alternatives at the time were
painful extractions without anesthesia or expensive hot gold fillings.
(27) The support from the ADA, coupled with the low cost of the mercury
amalgam fillings, effectively overshadowed the warnings from mercury
amalgam opponents. (28) Concerns about the safety of amalgam fillings
briefly resurfaced in Germany in the 1920s (29) but, subsequently,
diminished without a clear resolution. (30) The debate over the safety
of mercury amalgams continues today, and advances in scientific tests
have helped bolster the case against amalgams. (31)

III. FORMS OF MERCURY

Mercury is found in three forms: metallic or elemental, inorganic,
and organic. (32) Metallic or elemental mercury is a liquid at room
temperature and is silver-white in color. (33) It is the purest form of
mercury and is used in fluorescent light bulbs, batteries, dental
fillings, thermometers, and some light switches. (34) At room
temperature, exposed metallic mercury can evaporate. (35) This
invisible, odorless vapor is harmful to humans. (36)

Inorganic mercury is mercury combined with other elements. (37)
Inorganic mercury usually forms white powder or crystals (with the
exception of cinnabar, which is a red powder). (38) The third form of
mercury, organic mercury, is formed when mercury combines with carbon.
(39) The most common organic mercury compound is methylmercury, which is
produced when microscopic organisms convert inorganic mercury into
methylmercury. (40) Methylmercury is often found in soil or water, and
the primary way humans are exposed to this type of mercury is through
consumption of fish that contain methylmercury. (41)

All three forms of mercury (metallic, inorganic, and organic) are
found in the body. (42) Mercury in vapor form is usually attributed to
mercury amalgam fillings. (43) When the vapor escapes from the fillings,
it enters the bloodstream via absorption through the lungs and
intestinal tract. (44) Mercury vapor primarily targets the brain and
central nervous system. (45) Chewing, drinking hot foods, and tooth
brushing all exacerbate the release of mercury from dental fillings.
(46)

The second type of mercury found in the body is mercury in the
ionic form containing two positive charges. Ionic mercury does not move
around or through tissue like other forms of mercury, but ionic mercury
is, arguably, the most destructive form. It usually damages the kidneys
and gastrointestinal tract. (47)

The final form of mercury found in the body is methylmercury. (48)
Methylmercury is the organic form of mercury. (49) It is formed when
mercury vapor and ionic mercury come into contact with bacteria in the
mouth, stomach and intestinal tract, or in the bloodstream. (50) This
process of conversion is known as methylation. (51) Methylmercury is
able to cross any cell membrane or barrier in the body. (52) This
includes being able to cross the placenta and the blood-brain barrier.
(53) Once methylmercury reaches its destination, it is converted back
into ionic mercury. (54) Degeneration and atrophy of the sensory
cerebral cortex, paresthesia (numbness and tingling), hearing and visual
impairment are all attributed to poisoning by methylmercury. (55)

For thousands of years, mercury has aided advances in medicine,
chemistry, dentistry, and money. (56) In 2001, amalgam sales through
dental dealers totaled 39 million dollars, (57) but, today, mercury is
banned or in the process of elimination in almost every aspect of
society because modern scientists acknowledge mercury's dangers.
(58) For example, mercury use is being reduced in hospitals (59) and
schools nationwide. (60) Additionally, mercury-containing compounds are
no longer recognized as safe for veterinary use. (61) Recent legislation
also prohibits the use of mercury in childhood immunizations. (62)

The Environmental Protection Agency (EPA), the Food and Drug
Administration (FDA), and the World Health Organization (WHO) all
establish "safe limits" for daily mercury exposure. (63)
However, there are substantial variations in their recommendations
primarily because of the different safety margins used by each
organization. (64) The EPA sets the lowest limit at 0.1 mg/kg body
weight per day. (65) These limits are not invariable nor do they mean
that negative reaction is certain to occur above the recommended level.
Their levels only mean that mercury exposure below the recommended level
should not lead to health problems. (66) Dentists are regularly exposed
to 50-4000 mcg/cubic meter of mercury vapor daily. (67) Studies show
that glioblastomas (brain cancer) afflict dentists at twice the rate of
the general population and that twenty percent of Canadian dentists are
on long-term disability pensions as a result of mental health problems.
(68)

Although the use of mercury amalgams is waning and, in 2001, an
estimated twenty-seven percent of dentists reported to be practicing
mercury-free, mercury amalgams are still used to repair damaged teeth.
(69) The Centers for Disease Control and Prevention (CDC) attribute the
decrease in amalgam use to a decline in the amount of cavities in
children and young adults, a decrease in the size of cavities, earlier
detection of cavities, improved oral hygiene including fluoride and
sealant use, and possibly dietary modifications. (70) Although there has
been a decrease in mercury amalgam use, those dentists who continue to
use mercury amalgams in their practices use what is known as
encapsulated amalgam. (71)

IV. POISON PALETTE? FACTS ABOUT AMALGAMS

Dentists purchase amalgam capsules that contain mercury on one side
and a mixture of powdered metals collectively called dental alloy on the
other side. (72) Once the capsules are in the dental office, dentists
combine the two components inside the capsules by breaking the thin
plastic wall that separates the components, thus, creating the liquid
amalgam filling mixture. (73) The amalgam mixture is then placed into
the cavity in the tooth where it binds to the tooth as it hardens. (74)
The average dental restoration requires two capsules of amalgam. (75)
The label on the jars sent to dentist with the amalgam capsules states
in capital letters that the product "CONTAIN[S] METALLIC
MERCURY." (76) The label bears a skull and crossbones image next to
the word "POISON." (77) The label also lists other serious
health hazards that mercury may cause if it is ingested, inhaled or
comes into contact with the skin. (78)

In addition to the harsh warnings found on the outside of the
encapsulated amalgams bottle, a Material Safety Data Sheet (MSDS) is
also included in the packaging. (79) All products sold in the United
States are required to have a MSDS. A MSDS, "describes the
product's physical properties, health problems, fire risk data, and
other hazards associated with it." (80) The list of health hazards
on the MSDS for dental mercury states:

Even with the harsh warnings appearing on the label of the
encapsulated amalgams and the MSDS fact sheet accompanying the
encapsulated amalgams, the Food and Drug Administration (FDA) has not
evaluated the harmful effects of the amalgam mixture resulting when the
capsule is broken and the elements are mixed together in the
dentist's office. (81) In 1987, the FDA labeled the two separate
premixed components of dental amalgams, the amalgam alloy and the dental
mercury, as Class II and Class I devices, respectively. (82)

A Class I device is one that does not present a risk to humans and
is subject only to the general FDA controls for goods manufacturing
procedures. (83) A Class II device are those devices "for which
there is insufficient information to show that general controls
themselves will assure safety and effectiveness, but there is sufficient
information to establish special controls to provide such
assurance." (84) Special controls can include "performance
standards, post-market surveillance, patient registries, and the
development and dissemination of guidelines, recommendations, and other
appropriate actions" that the FDA deems necessary. (85)

The FDA admitted that there were risks associated with dental
mercury (i.e., mercury poisoning and adverse tissue reaction), but the
FDA decided general controls were sufficiently safe. (86) The general
controls included labeling the dental mercury with "adequate
directions for use." (87) In addition to the label, dental mercury
requires a warning that would "warn dentists about the rare risk of
allergic reactions among patients and the risk of toxicity to dental
health professionals." (88)

Although the FDA placed regulatory controls on the two separate
components of dental amalgams, it avoided regulation of the mixed
amalgams. (89) However, neither product by itself is an effective
filling material. The amalgam alloy or the mercury would wash away in
the saliva if either was used alone to fill a cavity. (90) In 1991, the
FDA director of Dental Devices stated that the mixed dental amalgam
cannot be regulated by the FDA because it is prepared by the dental
clinician. (91) The FDA claims that the mixing of mercury and dental
alloy is only a "reaction" product manufactured by dentists to
be used solely in their professional practices. (92) However, the FDA
regulates other materials like composite fillings and dental cements,
which are both prepared by the dental clinician. (93) The current FDA
classification of encapsulated amalgam has resulted, thus far, in
mercury amalgam mixture being exempted from federal regulation. (94) In
1998, mercury received the label of "not generally recognized as
safe" from the FDA. (95) However, the FDA failed to change the
label on the mercury used in dental fillings. (96) Dental mercury
continues to be labeled as a safe and effective Class I Dental Device by
the FDA. (97)

V. THE MERCURY AMALGAM CONTROVERSY

"Medicine is an inexact science, and eminently qualified
physicians may legitimately diverge in their beliefs as to what
constitutes the best treatment." (98) It is not likely that
physicians or dentists will all ever agree on how best to treat any
injury or ailment. This disagreement, to an extent, is beneficial to
society because it furthers research and debate. However, when one side
is unfairly advantaged, whether fiscally or politically, it harms
patients. The mercury amalgam debate has been active for years, but it
has only recently been brought back to the attention of the public
through media coverage and the internet. (99) On one side of the debate
are anti-amalgamists calling for the complete removal of mercury in
dental fillings and in other areas of society. The other side supports
the use of mercury amalgams, claiming that the "benefits of
restoring teeth with dental amalgam outweigh significantly the
documented risks." (100)

Arguably, mercury ranks as the second most poisonous compound on
earth, and no agency or health organization would dispute that mercury
is toxic. (101) There is significant debate over the potential harmful
effects of exposure to mercury through amalgam dental restoration, but
the arguments in favor of banning the use of mercury amalgams are
strong. Many healthcare organizations, including the American Public
Health Association, the California Medical Association, and Health Care
Without Harm, support a ban on any mercury-containing product used by
humans. (102) Current scientific research indicates that: 1) mercury
amalgams release a significant amount of mercury into the body, 2)
mercury from amalgams can cross the placenta and result in significant
exposure for infants, and 3) mercury exposure causes adverse effects in
the human body. (103) The World Health Organization (WHO) estimates that
dental amalgams release and the body retains three to twenty-seven
micrograms of mercury per day. (104) A report by the Centers for Disease
Control and Prevention (CDC) found that one out of every twelve women of
childbearing age has mercury levels above the "safe" threshold
of 5.8 parts per million in their blood. (105) One study estimates that
adults with as little as four amalgam fillings could experience health
problems, while children are at risk from two amalgam fillings. (106)
Further, there is scientific evidence linking mercury amalgams to
neurological problems, gastrointestinal problems, Alzheimer's
disease, brain damage in fetuses, cardiac dysfunction, autism, and
impaired kidney functioning. (107) A 2002 overview of the previous five
year's scientific literature dealing with mercury amalgams and
their health hazards uncovered three new possible links between mercury
amalgam and mercury accumulation in the eyes and testicles and mercury
causing impairment in kidney functioning. (108) Even the FDA does not
reject outright the potential for harm from mercury amalgam. The FDA
states:

At the mercury doses produced by amalgam fillings, the evidence is
not persuasive that the wide variety of nonspecific symptoms
attributable to fillings and "improvement" after their removal are
ascribable to mercury from the fillings. Conversely, the evidence
is not persuasive that the potential for toxicity at the levels
attributable to dental amalgams should be totally disregarded. The
potential for effects at levels of exposure produced by dental
amalgam restorations has not been fully explored. (109)

Although there is debate in the medical and academic communities
about the harmful effects of mercury amalgams, another argument
supporting a ban on mercury amalgams is that "fully adequate and
less toxic alternatives are available." (110) Alternatives include
gold, ceramic, porcelain, and polymeric filling materials. (111) Public
support and scientific evidence that support a ban on mercury amalgams
is growing, but the pro-amalgamists are standing firmly behind the
safety and continued use of mercury amalgams.

The American Dental Association (ADA) released a statement claiming
"[d]ental amalgam (silver filling) is considered a safe, affordable
and durable material that has been used to restore the teeth of more
than 100 million Americans." (112) The FDA and the United States
Public Health Service also promote the continued use of amalgam. (113)
The ADA touts as the advantages of mercury amalgams, lower cost, ease of
use, and greater durability as compared with alternative filling
materials. (114) Ultimately, the ADA claims that there is not enough
scientific evidence to prove the case against mercury amalgams and
maintains the position that "dental amalgam has been studied and
reviewed extensively, and has established a record of safety and
effectiveness." (115) To the limited extent that the ADA
acknowledges the harmful effects of mercury amalgams, it is only in
respect to the relatively small number of patients who suffer allergic
reactions to mercury. (116) The ADA does admit "[m]inute amounts of
mercury vapor (between 1-3 micrograms per day) may be released from
amalgam under the pressure of chewing or grinding, but there is no
scientific evidence that such low-level exposure is harmful." (117)
Dr. Walter Crinnion's skeptical view of the ADA's position on
mercury amalgams states, "'[i]t would bankrupt the ADA with
lawsuits if they were to admit how dangerous mercury fillings truly
are.'" (118) In fact, one estimate is that liability for
amalgam replacements and monetary damages could reach five trillion
dollars. (119)

There are many allegations that the American Dental Association and
amalgam manufacturers work together. The ADA is by far the dominant
trade group among dentists, with a membership equaling or exceeding
seventy percent of all American dentists. The ADA's monopolistic
grasp on dentists is evidenced by:

The seventy percent figure far exceeds the level of the bar (under
forty percent) or medical (under fifty percent) associations, and
perhaps any other health trade group. Unlike law and medicine, the
ADA has an ironclad "tripartite" system, meaning a dentist may only
join the local and state dental society by joining the American
Dental Association. The ADA controls the accreditation of dental
schools. Using that power, the ADA requires that dentists pass
tests of implanting mercury fillings, even though some dental
students consider it a health risk for themselves and their
patients. (120)

The American Dental Association argues there are no financial
connections between the ADA and amalgam manufacturers. (121) This is
disputed by many anti-amalgam advocacy groups. Consumers for Dental
Choice assert that the "ADA masquerades as a society focused on
dental health. Actually, the ADA works hand-in-glove with its secret
contractual partner, the amalgam manufacturers, to keep their fillings
in use and to prevent the public from learning they are mainly
mercury." Consumers for Dental Choice claim that the ADA endorsed
amalgams with the American Dental Association Seal of Acceptance after
receiving compensation from amalgam manufacturers. (122) The ADA says it
has never been paid as an endorser of amalgam products. (123) However,
the practice of requiring amalgam manufacturers to submit a fee with
their application for evaluation of a product was an established
practice from 1995 to 2002. (124) The reputed compensation took the form
of a "fee for processing" the seal of acceptance application
and constituted thirty percent of the costs. (125) The ADA states
"[b]e assured that the ADA does not profit from amalgam, nor does
it promote the material. The cost of maintaining the ADA Seal program is
financed primarily through ADA member dentist dues." (126)

In December 2004, the National Institutes of Health issued a report
regarding the safety of dental amalgams. (127) However, as a result of
the alleged wrongdoing in the contract award, the results of the report
are of questionable value. The contract was awarded to Life Sciences
Research Office, Inc. (LSRO) which, according to Charles Brown, counsel
for Consumers for Dental Choice, has a "history of building
[research] panels with conflicted members whose findings favor
industry." (128) Brown added, "LSRO is the tobacco
industry's consultant of choice." (129) Consumers for Dental
Choice claimed that LSRO was handpicked without a competitive bid, had
announced the desired results in advance of their study, and had
mandated the research panel be devoid of mercury researchers. (130)
Additionally, Senator Frank Lautenberg challenged the National
Institutes of Health to eliminate the "inherent conflict of
interest" resulting from the designation of organized dentistry
(which endorse mercury fillings) to be in charge of the research. This
entire process is currently under federal investigation. (131) Although
the ADA and other organizations maintain the position that mercury
amalgams are a safe filling material, they may be relying upon faulty
research. The anti-amalgam activists are intent on continuing research
into the harmful effects of mercury amalgams and on lobbying for a ban
on the use of mercury in the mouth.

VI. LITIGATION IS AN INSUFFICIENT REMEDY

The American Dental Association claims that there is not enough
scientific evidence to prove the case against mercury amalgams and
maintains the position that "dental amalgam has been studied and
reviewed extensively, and has established a record of safety and
effectiveness." (132) However, dentists, the ADA, and amalgams
manufacturers should be aware that lawyers are preparing the case
against mercury amalgams. (133) The scientific evidence against mercury
amalgams continues to mount, and plaintiffs will use the scientific
evidence in litigation against dentists and amalgam manufacturers. The
problem with litigation, however, is that patient plaintiffs must meet a
high burden of proof to win a lawsuit against the dentists or the
amalgam manufacturers. (134)

Exposure to mercury, a heavy metal, may result in cranial and
peripheral nerve injury, but oftentimes, the injury as a result of
mercurial poisoning is hard for the patient plaintiff to prove. (135) In
order to prove a claim of nerve injury due to toxic substance exposure,
plaintiffs must pass a two-prong test, First, the plaintiff must have
symptoms consistent with those of an injury from the suspected toxin.
(136) Second, plaintiffs must prove that their level of exposure to the
suspected toxin was potentially high enough to cause such injury. (137)

Often, it is hard to prove toxic neuropathy because evidence
surrounding the exposure and the resulting injury is inconclusive and
ambiguous. (138) Two tests are available to establish a person's
level of mercury exposure. (139) The first test available is a blood
test. (140) "Blood tests can detect exposure to all three types of
mercury (metallic, inorganic, and organic), but blood tests must be done
within a few days of exposure in order to be accurate." (141)
Additionally, consuming fish before the test can influence the results.
(142) The second test is a urine mercury test. (143) It can detect
metallic and inorganic mercury exposure, but because organic mercury is
not excreted from the body in urine, the urine test cannot detect
organic mercury. (144) Mercury exposure gradually causes debilitation
and injury and the likelihood that patient plaintiffs would be able to
prove causation sufficient to meet the high burden of proof is unlikely.
(145)

Another reason litigation is insufficient is that a failure to warn
case against an amalgam manufacturer has already failed. (146) In
Environmental Law Foundation v. Wykle Research, the plaintiff alleged
that the amalgam manufacturer failed to provide a clear and reasonable
warning with its shipments of dental amalgam in violation of Proposition
65. (147) The court held that Wykle's warning was sufficient to
comply with what is required by the "safe harbor" provision in
Proposition 65 regardless of the fact that the warning was small,
"combined with information required by the American Dental
Association and did not refer specifically to mercury." (148) The
rationale for this decision was that the warning would be read by
dentists and dental workers and there was no reason to assume these
workers would not read or understand the warning. (149) Additionally,
the "safe harbor" requirement of Proposition 65 was not
intended to create a hierarchy of warnings or require manufacturers to
use the best warning; its intent was only to require a "simple and
reasonable" warning. (150) Given that a failure to warn case
against an amalgam manufacturer failed in a state with strict and
progressive laws against mercury, the likelihood that a plaintiff would
succeed in another jurisdiction is low.

In another amalgam-related case, Dr. Barnes, a dentist, brought an
action against Kerr Corporation, a dental amalgam provider, for
"negligence, the manufacture and sale of a defectively designed
product, the failure to warn, intentional concealment, the failure to
disclose a known defective condition, and breach of implied
warranty." (151) Barnes alleged he was injured by exposure to
mercury primarily through "mercury vapor and mercury contained in
amalgam particulate inhaled when removing existing amalgam from the
teeth of patients." (152) Barnes' expert witness testified
that "between 81 percent--89.3 percent of Barnes' daily
exposure came from this source." (153) Kerr refuted this by stating
that there were no facts to support that Kerr manufactured the majority
of amalgams Barnes removed during his career. (154) The expert witness
then testified that between 2.5 percent to 10 percent of Barnes'
daily exposure came from contaminated dental office air and between 7.5
percent to 8.2 percent came from alleged exposure to mercury vapor and
particulate produced when placing new amalgam fillings. (155) Kerr
argued that exposure in the office air could have come from other
sources. (156) Kerr supported this assertion by stating that because Dr.
Barnes normally placed new fillings without the aid of a drill, he would
not, therefore, be exposed to mercury when placing new fillings. (157)
Additionally, Kerr accused Barnes' expert witness of
"inject[ing] untested, unreliable, and speculative 'courtroom
science' into these proceedings.... " (158) The district court
held the expert witness testimony, which endorsed "a strong
minority view that dental amalgam containing mercury is both
unreasonably dangerous and hazardous to human health," was
admissible. (159) Unfortunately, the court granted summary judgment in
favor of Kerr Corporation stating that Barnes did not meet the test for
proximate cause. (160) Further, the court ruled that Kerr's
warnings were sufficient. (161) Historically, reactive mercury amalgam
litigation has not provided redress for those harmed by mercury amalgam
fillings. Although some of the cases were dismissed on procedural
grounds, proactive legislation is the best way to protect the patient
and the dentist.

VII. REMOVAL Is AN INSUFFICIENT REMEDY

Although the debate over the use of mercury amalgams continues,
most experts on either side agree that there is no need to remove silver
fillings that are intact. (162) There are two reasons to avoid removing
dental amalgams. First, incorrect removal may be more harmful than
leaving the amalgam in the mouth. (163) The amount of mercury swallowed
or leaked into the mouth through improper removal methods may be higher
than that released from the intact dental amalgams. (164) Consumers for
Dental Choice warns, "[o]nce the removal has begun, the mercury
vapor will be continuously released from the tooth. During the removal
or placement of amalgam the patient can be exposed to amounts which are
a thousand times greater than the Environmental Protection Agency's
allowable concentration." (165) Further, there are cases penalizing
dentists for removing patients' mercury amalgam fillings
"without an independent diagnosis of mercury toxicity or other
valid diagnostic evidence." (166) The ADA states "[b]ased on
current scientific data, the ADA has determined that the removal of
amalgam restorations from the non-allergic patient for the alleged
purpose of removing toxic substances from the body, when such treatment
is performed solely at the recommendation or suggestion of the dentist,
is improper and unethical." (167) One dentist only advises patients
to have mercury amalgams removed if the fillings are large and may make
the tooth weak over time. (168) The dentist also advises that only one
quarter of the fillings in the mouth be removed and replaced at a time.
(169) The second reason to avoid removal of intact amalgam filling is
that removal is costly. (170) Although removal is not a recommended
remedy in most cases, in some cases removal may be the only way for
patients to gain relief from their symptoms.

If a patient decides to have a mercury amalgam removed, the
International Academy of Oral Medicine and Toxicology offers the
following guidelines, which may help reduce mercury exposure during the
removal process. (171) Removal should be done under a cold water spray
to keep the temperature low and reduce the vapor pressure within the
mercury. (172) A high volume evacuator should be kept next to the
patient's tooth so that it may suction out mercury vapor and any
amalgam particulates. (173) After the old amalgams are removed, the
tooth needs to be washed with cold water for at least sixty seconds.
(174) To protect the dentist and the staff, nitrile rubber gloves should
be used because nitrile is a better barrier against mercury vapor than
rubber or vinyl gloves. (175) Also, staff should wear respirators to
prevent them from inhaling the mercury particulates or vapor. (176) Once
the source of the mercury exposure is removed (i.e., mercury amalgams
are removed from patients' teeth or environmental exposure ceases),
there are many effective ways to remove the mercury remaining in
patients' bodies.

Mercury removal from the body is usually done through a process
called chelation. (177) Some doctors recommend natural remedies like
chlorella or cilantro to remove mercury from the body, but
dimercaptosuccinic acid (DMPS) and sodium dimercaptopropane sulfonate
(DMSA) are the two most popular remedies to remove mercury from the
body. (178) DMPS (Sodium 2, 3-imercaptopropane-l-sulfonate) binds with
heavy metals such as copper, zinc, and mercury, and it has been
demonstrated that DMPS can eliminate these metals from the connective
tissues in the human body. (179) DMSA (meso-2, 3-dimercaptosuccinc acid)
is another acid used as a mercury chelation agent. DMSA penetrates the
brain cells and removes mercury both through the kidneys and through
bile. (180) Although both DMPS and DMSA remove mercury from the body,
neither is one hundred percent effective, and both processes can be time
consuming and painful. (181)

VIII. ENVIRONMENTAL IMPACT

"Dental offices contribute approximately fifty-four tons of
toxic mercury to the environment each year." (182) "Even if
amalgam placement stopped today, mercury-bearing amalgam would continue
to be removed and put into the waste stream for the next twenty to
thirty years." (183) Both the unused dental amalgam fillings and
amalgams that have been removed must be treated as toxic waste (184)
Scrap amalgam cannot be "thrown in the trash, buried in the ground
or incinerated." (185) Rather, there are special disposal
procedures that must be followed. Some states are in the process of
proposing legislation that would mandate the use of advanced filtration
devices in dental offices. (186) These filtration devices are known as
amalgam separators.

Other states have already passed the mercury disposal legislation
and the deadlines for compliance are near. (187) A Washington state law
requires that dentists capture and recycle dental mercury. (188) For
example, an ordinance in King County, Washington, requires that amalgam
separators be installed in dental offices. (189) Originally, in 1994,
King County dentists could voluntarily remove mercury from dental
wastewater; however, in 2001, King County made it a mandatory
requirement to remove mercury-containing dental amalgam from wastewater.
(190) San Francisco also requires dental offices have amalgam separators
installed. (191) New York has proposed amalgam separator legislation
that also includes extracted teeth as a source of dental amalgam waste.
(192) It seems the King County mercury reduction program is successful.
Approximately, ninety-seven percent of the dental offices in King County
have amalgam separators and, thus far, the level of mercury entering the
County wastewater treatment system decreased by fifty percent. (193)

Amalgam separators use a variety of techniques to remove mercury
from wastewater. (194) The techniques are sedimentation, filtration,
centrifugation, and ion exchange. (195) Most separators use some form of
sedimentation technology; many times sedimentation is coupled with
another removal technique. (196) Amalgam particles are heavier than
water; thus, they settle easily from suspension in water. (197) In one
study, ninety percent of amalgams settled from water within two hours.
(198) Even though sedimentation is the most common removal technique
followed by filtration, all of the techniques have at least a
ninety-five percent removal effectiveness according to international
standards. (199) A 2005 study reported that amalgam separators only
require a modest increase in operating expenses. (200) The study
estimates that amalgam separators can be purchased for $215 to $6000 and
can be operated for $47 to $100 per month. (201)

Another environmental problem arises when people die with mercury
amalgam dental fillings. Approximately thirty percent of adults choose
cremation. (202) In 1099, a joint study by the EPA and the Cremation
Association of North America found that crematoria released
approximately 238 pounds of mercury that year. (203) There is no
national legislation requiring removal of amalgam fillings before
cremation nor are there regulations requiring filtration devices on
crematoria incinerators. Although two states introduced legislation
regarding mercury emission from crematoria, neither bill passed. (204)

In Scotland, where cremation is one of the biggest sources of
mercury pollution, the Scottish Government is taking action. (205) The
government's requirement of filtration devices on crematoria
incinerators will reduce emission from crematoria by fifty percent by
2012. (206) A temporary solution to the problem of pollution by
crematoria is to require filtration devices. However, a permanent
solution would be a ban on the use of mercury amalgam fillings; thus, in
the future, pollution by the crematoria would cease to be a problem.

"To restrict the supply of mercury to society ... is an
effective way to reduce the risks to human health and the environment
instead of using pollution control measures and collecting and taking
hazardous waste into safekeeping." (207) Although environmental
legislation is good, it is not sufficient to solve the problem at hand.
Federal legislation will address the problem at the source before it
enters the human body or contaminates the environment.

IX. LEGISLATION IN OTHER COUNTRIES

Many countries have taken steps to limit the use of mercury
amalgams and to protect their citizens. Sweden was the first country to
ban all amalgam fillings. (208) Sweden banned the use of amalgam in both
adults and children since 1997. (209) Austria, Denmark, and Norway also
have a complete ban on the use of mercury amalgams. (210) A 1995
Canadian health report noted that "[d]ental amalgam contributes
detectable amounts of mercury to the human body and is the largest
source of mercury exposure for average Canadians." (211) The report
concluded that "exposure [from dental amalgams] is not causing
illness in the general population." (212) Currently, Canada
recommends "mercury fillings not be given to children, pregnant
women, or people with kidney problems, braces, or mercury
hypersensitivity," but Canada does not ban all amalgam filling.
(213)

Germany has a partial ban on mercury amalgams prohibiting the use
of amalgams in patients with kidney impairment and strongly advising
against the use of amalgams in children and pregnant women. (214)
Further, the world's leading amalgam manufacturing company,
German-owned Degussa, has ceased manufacturing mercury amalgams entirely
and has switched all of its production to alternative filling materials.
(215) Many countries have banned mercury amalgams, but the United
States, Canada, and many other Western European countries have yet to
definitively follow the lead; however, legislation enacted at the state
level indicates a shift in public opinion toward a ban on mercury
amalgams. (216)

X. STATE-LEVEL LEGISLATION

California was the first state to address the mercury amalgam
issue, albeit indirectly, with the passage of Proposition 65. (217)
Because of the general language of Proposition 65, the statute applied
to mercury amalgams and survived preemption by the Medical Device
Amendment of the Food, Drug and Cosmetics Act. (218) Proposition 65
requires people who used certain identified reproductive toxins to warn
patients and employees of the toxins' harm. (219) The list of
identified toxins included mercury; thus, the warning requirement
applied to mercury amalgams. (220) When a group of amalgam manufacturers
challenged Propositions 65's application to dental amalgam, the
Court of Appeals for the Ninth Circuit upheld the statute's warning
requirements as applicable to dental amalgams. (221)

Other states have tried to regulate mercury amalgams through a more
circuitous route. Connecticut passed the Mercury Reduction and Education
Act of 2002. (222) This legislation "bans or phases out
mercury-containing products" but does not specifically address
dental amalgams. (223) Mark Breiner, a Connecticut dentist, said his
state banned mercury because it was dangerous to the environment. He
said:

What's toxic to the environment doesn't belong in the mouth. You
don't even have to have any science. All you have to have is common
sense. If I take a filling out of a patient's mouth, that filling
has to be treated as hazardous waste. I cannot throw that in the
garbage ... I could be fined and arrested. And before it goes in
the mouth, it's treated as a toxic substance .... (224)

After a group of environmentalists asked for clarification of the
state's position on dental amalgams, the commissioner of the State
Department of Environmental Protection announced that the state cannot
legally ban dental amalgams. (225) The commissioner reviewed the
legislative history and the phrasing of the Act and concluded that the
lawmakers' intent was not to ban mercury-containing dental amalgams
through this legislation. (226)

The Pennsylvania Department of Environmental Protection started its
Mercury Reduction Initiative in January 2004. (227) The initiative aims
to reduce mercury in the environment by collecting leftover elemental
mercury from dental offices and offering best management practices for
mercury-bearing amalgam waste. (228)

While Proposition 65's language was not specific to mercury
amalgams, many other states including Maine, (229) New Hampshire, (230)
Arizona, (231) Ohio, (232) and Washington (233) have enacted legislation
specifically addressing the mercury amalgam issue. (234) There are two
problems with this amalgam-specific state-level legislation. First,
amalgam-specific state-level legislation may not survive federal
preemption. (235) While Proposition 65 evaded preemption due to its
non-specificity with regard to mercury amalgams, amalgam-specific
state-level legislation could be preempted if the statute were specific
to a particular device. (236) Second, although state-level legislation
aims to protect patients, it does not extend far enough. Most of the
state-level legislation requires dentists only to warn patients about
the harmful effects of mercury. (237) A mere warning is insufficient. A
warning does not prevent dentists from continuing to use mercury
amalgams in their practices. The state-level amalgam-specific
legislation also does not require insurance companies or Medicaid to pay
for alternative filling materials nor does it offer any sanctions for
dentists who violate the .statutes. (238) Federal legislation would
address and correct these shortcomings. For these reasons, federal
legislation is the best solution to the mercury amalgam problem.

XI. NATIONAL LEGISLATION

Representative Diane Watson of California first introduced federal
legislation to combat mercury amalgam in 2002. (239) The bill did not
pass but was referred to the House Subcommittee on Health where it
expired. (240) The bill was reintroduced to the 109th Congress and,
again, it was referred to the House Subcommittee on Health. (241) The
current bill would amend the Food, Drug and Cosmetics Act to prohibit
the "introduction into interstate commerce ... mercury intended for
use in a dental filling" effective January 1, 2009. (242) During
the transition period, effective December 31, 2006, mercury intended for
use in dental fillings must bear a label stating the following:

Dental amalgam contains approximately fifty percent mercury, a
highly toxic element. Such product should not be administered to
children less than eighteen years of age, pregnant women, or
lactating women. Such product should not be administered to any
consumer without a warning that the product contains mercury, which
is a highly toxic element, and therefore poses health risks. (243)

Although Representative Watson's legislation is commendable,
it is lacking in two areas. The Mercury in Dental Filling Disclosure and
Prohibition Act, similar to the amalgam-specific state-level legislation
discussed above, fails to require insurance companies or Medicaid to pay
for alternative filling materials and does not provide sanctioning for
dentists who violate the statute. The solution to the first loophole in
the legislation is to add language similar to that proposed in
Washington that requires a "modification of dental insurance
coverage to include mercury amalgam dental restorative
alternatives." (244) Requiring insurance companies that provide
dental benefits to cover non-mercury fillings to at least the same
extent they cover mercury fillings would be beneficial. This change in
the legislation would allow low income families on Medicaid to choose a
desirable filling material, since currently under Medicaid their only
choice is "mercury fillings or no fillings at all." (245)
Persuading insurance companies to cover alternative materials would also
aid moderate income families who are often forced to pay out-of-pocket
for alternative filling materials because they are not covered by most
insurance companies. (246) Patients must not be induced into receiving
mercury amalgams because they cannot pay for alternative filling
materials; patients must be given a choice. Allowing patients a choice
in their treatment alternative is not akin to giving authority to every
alternative school of thought. (247) "Without doubt, it is
reasonable for the State to outlaw witch doctors, voodoo queens,
bee-stingers and various other cults which no reasonably intelligent man
would choose for the treatment of his ills.... " (248) Continuing
the analysis further to determine where the dividing line is between
good medicine and quackery, the England court held "[u]nder all of
the cases, we think it is that the State cannot deny to any individual
the right to exercise a reasonable choice in the method of treatment of
his ills, nor the correlative right of practitioners to engage in the
practice of a useful profession." (249) It is not unreasonable to
fully inform dental patients of their treatment options for their tooth
fillings. In addition to including insurance coverage of alternative
filling materials in the statute, a section punishing dentists who
violate the statute should also be added.

To address the oversight in sanctioning, the statutes must be
amended to add a three-tiered penalty structure starting with a fine for
the first violation, moving to a three-month suspension of the dental
license for a second offense, and resulting in permanent suspension of
the dental license for a third violation. This penalty structure may
seem harsh, but failing to warn a patient of the potentially
life-altering and debilitating effects of mercury before placing
amalgams in their mouths is a breach of the dentists' fiduciary
duty to their patients, (250) and this failure should be punished.

A benefit of federal legislation, as opposed to state-level
legislation, is uniformity. The same is true for the sanctions for
violation of the statute. By stating the sanctions within the statute,
it ensures that all offenders will be punished equally. It may seem like
sanctioning dentists who violate this statute is an area which should be
left to the states to regulate. However, United States v. Dicter held
that the "right to practice medicine was property subject to
forfeiture under 21 U.S.C. [section] 853." (251) While other
professional licenses have been forfeited under federal law, Dicter was
the first appellant to challenge a federal court's statutory and
constitutional authority to forfeit his license to practice. (252)
Dicter lost his case and his medical license was revoked. The court held
defendant's medical license is forfeitable to the government
"irrespective of any provision of state law." (253) Dentists,
like medical doctors, receive their licenses to practice from the state.
Therefore, even though a dental license is state-issued, it is likely
that [section] 853 would still apply, and the federal government would
be able to usurp a dental license from a dentist who violates federal
law.

XII. CONCLUSION

Mercury amalgam use is waning as governments and the public become
aware of the deleterious effects of mercury. However, the mercury
amalgam controversy continues. As of now, litigation is an insufficient
remedy for injured patients because it is hard for the patient plaintiff
to meet the burden of proof with regard to proximate cause. Further,
injured patients may not choose removal of amalgams because the removal
process may be more harmful than living with daily exposure to mercury.
In addition to an injurious effect of mercury in the mouth, amalgam
waste from dental office wastewater and from crematoria are harming the
environment. Other countries regulate or completely prohibit the use of
mercury in some or all of their populations. Further, some states have
recognized the risks of mercury amalgams and have enacted state-level
legislation to combat the problem. The above remedies are helpful, but
they are not completely adequate.

Congress must pass comprehensive national legislation to completely
ban the use of mercury amalgam dental fillings in the United States. If
dentists stop using mercury as a filling material now, the harm does not
end. There will still be people injured from previously placed mercury
fillings, and the issue of mercury amalgam waste removal still remains.
Immediate action by Congress to ban mercury in future dental fillings
would be valuable. As each session of Congress closes without the
passage of the Mercury in Dental Filling Disclosure and Prohibition Act,
the longer dentists are able to place a toxic substance into their
unsuspecting patients' mouths. Congress needs to act quickly to
amend the legislation to include insurance coverage of alternative
materials and to include sanctions for those who violate the statute.
Congress must pass legislation regulating the use of mercury amalgams in
order to stop the perpetuation of harm on the American people by the
hands of dental professionals.

(16) Scientific Case. supra note 13. The English Crowcour brothers
used the silver filling in their New York City dental practice which
opened in 1833. The brothers heralded the praises of the so-called
"silver fillings" because they were a cheap alternative to
gold fillings. Id.

(61) Nationwide Recall of Miracle Leg Paint, 17 FDA VETERINARIAN 4
(2002). A horse died after receiving bi-weekly applications of a
mercuric chloride blistering agent to its legs. Mercuric chloride
blistering agents were used to treat lameness, shin bucks, bows, chips,
splints, and other horse leg ailments, but that practice is now
outdated. Owners brought the horse to the veterinary hospital after it
became frantic and maniacal. Toxicology reports after the horse's
death revealed heavy metal poisoning. Id. The author ponders if mercury
containing products are not fit for use in animals, can they possibly be
safe for humans? The FDA said:

There are no approved veterinary drug products that contain mercury
as an active ingredient, and the use of mercuric blistering agent
is not generally recognized as safe and effective. There are safety
concerns for humans handling the products containing mercuric
blistering agents. Poisoning and death have occurred in humans
after applying the mercuric chloride products to large areas of the
skin.

(67) Jule Klotter, Quecksilber: The Strange Story of Dental
Amalgam, TOWNSEND LETTER FOR DOCTORS AND PATIENTS, July 1, 2005, at 107.

(68) Id. at 107.

(69) Id. "The American Dental Association estimates that the
dental industry places approximately 70,000,000 dental amalgams
annually, and each dental amalgam may contain one half to three fourths
of a gram of mercury, depending on the size of the filling."
Mercury in Dental Filling Disclosure and Prohibition Act, H.R. 4011,
109th Cong. (2005).

(70) Centers for Disease Control and Prevention, Dental Amalgam Use
and Benefits, Sept. 2001,
http://www.cdc.gov/oralhealth/factsheets/amalgam.html.

(78) Id. The label warns that ingestion of mercury could cause
"Neurotoxic/Nephrotoxic effects," that the inhalation of
mercury could cause "Bronchiolitis, Pneumonitis, [and] Pulmonary
Edema," and that even skin contact with mercury could have harmful
effects including "redness and irritation to [the] eyes and
skin." Id. at 587.

(82) Congratulating American Dental Association for Sponsoring
Second Annual "Give Kids a Smile" Program, Testimony Before
the Subcommittee on Human Rights and Wellness, 108th Cong. (2004)
[hereinafter Give Kids a Smile] (statement of Richard Fischer, dentist
and past president of the International Academy of Oral Medicine and
Toxicology).

(102) Mercury in Dental Filling Disclosure and Prohibition Act,
H.R. 4011, 109th Cong. (2005). The International Academy of Oral
Medicine and Toxicology (Orlando, FL), the American Academy of
Biological Dentistry (Carmel, CA), and the Holistic Dental Association
(Denver, CO) are all national dental societies that support a ban on
mercury amalgams. Letter from Charles G. Brown, Counsel, Consumers for
Dental Choice, to Janis Pappalardo, Bureau of Economics, Federal Trade
Commission (Feb. 11, 2003), available at
http://www.ftc.gov/ogc/healthcare hearings/docs/030612mcclure2.pdf
[hereinafter Brown Letter].

(103) Scientific Case, supra note 13.

(104) H.R. 4011, supra note 102. The amount of mercury retained in
the average human each day from mercury amalgams is higher than from any
other source of mercury, ld.

(105) CENTERS FOR DISEASE CONTROL, SECOND NAT'L REP. ON HUMAN
EXPOSURE TO ENVTL. CHEMICALS (Jan. 2003). Another agency which sets the
"safe" threshold for mercury levels in humans is the
Environmental Protection Agency. M. The fact that one in twelve women
have unsafe levels of mercury in their blood could place between 60,000
and 320,000 newborns at risk of neurological damage from mercury
exposure in utero. Id.

(106) Do & Klinghardt, supra note 6. But see David C. Bellinger
et al., Neuropsychological and Renal Effects of Dental Amalgam in
Children, 295 JAMA 1775 (2006); Timothy A. DeRouen et al.,
Neurobehavioral Effects of Dental Amalgam in Children: A Randomized
Clinical Trial, 295 JAMA 1784 (2006). Both studies conclude that
traditional mercury amalgams are safe for school-age children. However,
the studies do not look at the safety of amalgams in children younger
than six years old. Kathleen Doheny, Mercury in Dental Fillings Safe for
School-Age Children (June 29, 2006),
http://www.medicinenet.com/script/main/art.asp?articlekey=62728.

(108) MATHS BERLIN, THE DENTAL MATERIAL COMM'N, MERCURY IN
DENTAL FILLING MATERIALS: AN UPDATED RISK ANALYSIS IN ENVTL. MED. TERMS
(2002), available at http://www.toxicteeth.org/berlinbilaga.doc. Berlin
is the former Chair of the World Health Organization (WHO) Task Group on
Environmental Health Criteria for Inorganic Mercury. Id.

(111) United States Army Corp of Engineers & The Louis Berger
Group, Inc., Detailed Study of Non-Mercury Alternatives as an
Environmental Attribute, (2005),
http://www.mercurypolicy.org/new/documents/NonMercuryAIternatives
USMilitary0206.pdf (last visited Feb. 23, 2007). A new device is
currently being tested to repair a damaged tooth with a ceramic filling
in under an hour. Previous methods used for ceramic repair required
patients to return for a second visit. Ceramic fillings are natural
looking and have been proven "precise, safe, and effective."
Local Dentist Creates High-Tech Fillings, THE MEDINA GAZETTE (Medina,
Ohio), Oct. 5, 2005, at A6.

(114) ADA Statement, supra note 112. Dr. Frederick Eichmiller,
Director of the Paffenbarger Research Center, a dental research facility
states, "in some situations, like large cavities in the rear
molars, or cavities below the gum line, amalgam is often used ...
because it is one of the best filling materials" for places that
are difficult to keep dry. Press Release, American Dental Association,
Science Versus Emotion in Dental Filling Debate: Who Should Decide What
Goes in Your Mouth? (July 2002), available at http://www.ada.org/
public/media/releases/0207_release06.asp.

(118) Brouillette, supra note 3. Dr. Crinnion is the director of
the Environmental Center of Excellence at the Southwest College of
Naturopathic Medicine and Health Sciences in Tempe, Arizona, and he is a
nationally renowned expert in recognizing and treating heavy metal
toxicity.

(119) MEZEI, supra note 56.

(120) Petition to the Attorney General of Maine and to the Federal
Trade Commission, Boston Regional Office (Apr. 12, 2005) available at
http://www.toxicteeth.org/ natcamp_stategovt_ME 042005.cfm.

(132) ADA Statement, supra note 112. "[T]here are 1,500
articles that we know of that talk about the threat to human beings from
amalgams and mercury in dental filling. The scientists from Sweeden
found 700 articles that are credible, and I cannot figure out why our
health agencies can't find one.... " See also Consumer Choice
Hearing, supra note 74.

(162) Garrett Condon, Department of Environmental Protection
Won't Act to Ban Mercury Fillings, THE HARTFORD COURANT (Conn.),
Sept. 9, 2005, at 1. For a DVD demonstration of the history of mercury,
the adverse health effects, and a demonstration for safe removal, refer
to a documentary entitled Quecksilber: The Strange Story of Dental
Amalgam which is available for purchase online. Klotter, supra note 67,
at 107.

(170) Condon, supra note 162, at 1. One source quotes each
replacement filling as costing between seventy-five to two hundred
dollars, not including the office visit fee. Further, many times these
replacements are not covered by insurance companies. Julie Deardorff,
Are Your Teeth Toxic? The Mercury in 'Silver' Fillings Would
Be Hazardous Waste in a River--Yet It's Sitting in Your Mouth,
CHICAGO TRIBUNE, Dec. 11,2005, at Q.

(179) Do & Klinghardt, supra note 6. DMPS also binds with
arsenic, cadmium, lead, silver, and tin. DMPS is water soluble and has
been used as an effective treatment of metal intoxification since the
1960s. It is not recommended that DMPS be administered to patients who
still have any mercury fillings in their mouths, Id. But see LIFE
SCIENCES RESEARCH OFFICE, INC., REVIEW .AND ANALYSIS OF THE LITERATURE
ON THE HEALTH EFFECTS OF DENTAL AMALGAM, (2004),
http://www.lsro.org/articles/amalgam_report.html (last visited Feb. 23,
2007) (claiming that DMPS agents mobilize mercury from the kidneys but
not from the brain).

(180) Do & Klinghardt, supra note 6. Other alternative remedies
for removing mercury are through the use of chlorella, an algae, which
absorbs toxic metals from the environment; cilantro, an herb, which
moves the mercury, aluminum, lead, and tin that has accumulated in the
brain and spinal cord to the connective tissue where it is believed to
be excreted from the body; vitamin E seems to act as a protective agent
when the brain is exposed to mercury; vitamin C helps move mercury from
storage in cells so that it may be excreted from the body. Id. Chelation
therapy with DMPS or DMPA are recognized to have adverse side effects
including headaches, dizziness, nausea, and loss of other metals, which
are important to body functioning. LIFE SCIENCES RESEARCH OFFICE, supra
note 179.

(192) N.Y Environmental Conservation Law [section] 27-0926
(McKinney 2003). There is also proposed New York legislation which would
regulate the management of mercury and dental amalgam wastes at dental
facilities. 6 NYCRR Part 374-4.

(250) AM. DENTAL ASS'N PRINCIPLES OF ETHICS & CODE OF
PROF'L CONDUCT [section] 1 (2005). "The dentist has a duty to
respect the patient's rights to self-determination and
confidentiality." Id. "The dentist should inform the patient
of the proposed treatment and any reasonable alternatives in a manner
that allows the patient to become involved in treatment decisions."
Id.

(1) the district court improperly permitted an eleven-person jury
to return the forfeiture verdict; (2) the district court
erroneously instructed the jury that the elements of forfeiture
must be proven by a preponderance of the evidence; (3) Defendant's
medical license is not property subject to forfeiture under 21
U.S.C. [section] 853(a)(2); (4) the forfeiture of Defendant's
medical license required compliance with state administrative
procedures governing the revocation of a license by the Georgia
medical licensing board; (5) the district court's conduct of
forfeiture proceedings, while the state licensing board was
investigating the revocation of Defendant's medical license,
violated the Younger abstention doctrine; (6) the forfeiture of
Defendant's medical license violates the Tenth Amendment; and (7)
the forfeiture of Defendant's medical license violates the Eighth
Amendment.

Id.

KIMBERLY M. BAGA, J.D., cum laude, 2007, Cleveland-Marshall College
of Law, Cleveland State University. The author would like to dedicate
this note to her parents, Louis and Karen Baga, for their love, support,
and inspiration.

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